Bone plating system

ABSTRACT

The present invention relates to a bone plating system and method for fracture fixation of bone. The bone plating system includes a bone plate, at least one locking screw, and at least one non-locking screw. The bone plate has locking holes with threads and non-locking holes. The locking screws have a shaft with a thread for engaging bone and a head with a thread configured and dimensioned to mate with the thread of the locking holes. The non-locking screws have a thread for engaging bone and a non-threaded head. Both the locking and non-locking screws remain seated in their respective holes for substantially as long as the bone plate is implanted. The non-locking screws compress the bone plate against the bone and hold fracture reduction while the locking screws are secured to the plate at a fixed angular relationship. The mixed fixation achieved by this bone plating system and method is particularly useful for treatment of per-articular fractures.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.09/660,287, filed on Sep. 12, 2000 now U.S. Pat. No. 6,626,486, whichclaims the benefit under 35 U.S.C. § 119(e) of U.S. ProvisionalApplication No. 60/153,239, filed on Sep. 13, 1999.

FIELD OF THE INVENTION

The present invention is directed to a bone plating system for fracturefixation, and in particular to a system including a bone plate havingplate holes for both locking and non-locking screws.

BACKGROUND OF THE INVENTION

The clinical success of plate and screw systems for internal fixation offractures is well-documented. However, treatment of certain fractures,such as peri-articular fractures, which require a fixed angularrelationship between the bone plate and screws, remains problematic.Fixed angle devices for treatment of these fractures are available andinclude the Dynamic Condylar Screw System commercially available fromSynthes (USA) of Paoli, Pa. and a wide variety of blade plates. All ofthese devices require a high level of surgical skill, suitable bonequantity and quality, and a fracture pattern compatible with the device.

In cases in which these requirements are not satisfied, e.g. severelycomminuted bone or missing bone segments, conventional bone plate andscrew systems must be used. Although these conventional systems areparticularly well-suited to promoting healing of the fracture bycompressing the fracture ends together and drawing the bone into closeapposition with other fragments and the bone plate, the angularrelationships between the plate and screws are not fixed and can changepostoperatively. This can lead to mal-alignment and poor clinicalresults.

The primary mechanism for the change in angular relationship is relatedto energy storage. As previously noted, threading a bone screw into bonecompresses the bone against the plate. The compression results in highstrain in the bone, and, consequently, energy storage. With the dynamicloading resulting from physiological conditions, loosening of the plateand screw and loss of the stored energy can result.

Securing the screws to the plate provides a fixed angle relationshipbetween the plate and screw and reduces the incidence of loosening. Onemethod of securing the screw to the plate involves the use of so-called“locking screws.” A locking screw has threading on an outer surface ofits head that mates with corresponding threading on the surface of aplate hole to lock the screw to the plate. Bone plates having threadedholes for accommodating locking screws are known. For example, GermanPatent Application No. 43 43 117 discloses a bone plate with threadedholes for locking screws. As the relationship between the locking screwsand the plate is fixed, locking screws provide a high resistance toshear or torsional forces. However, locking screws have a limitedcapability to compress bone fragments.

In summary, conventional bone screws, i.e. screws that are not securedto a plate so that a fixed angular relationship between the plate andscrew is maintained (hereinafter “non-locking screws”) effectivelycompress bone fragments, but possess a low resistance to shear forcethat can lead to loosening of the screw. Locking screws have a highresistance to shear force that ensure stability at the bone screw/platehole interface, but possess a limited ability to compress bonefragments. Thus, a bone plating system that combines non-locking screwswith locking screws would be ideal for certain clinical situations.

U.S. Pat. No. 5,601,553 discloses a locking plate and bone screw. Theplate has a plurality of threaded plate holes for receiving lockingscrews. The plate also has non-threaded plate holes for receivingtemporary screws that keep the plate in place while the locking screwsare inserted. After the locking screws are inserted, the temporaryscrews are removed. Thus, the long term benefits of combiningnon-locking screws with locking screws are not obtained. U.S. Pat. No.5,709,686 discloses a bone plate with partially threaded plate holes.The partially threaded holes allow either non-locking or locking screwsto be used. Because the plate holes are only partially threaded, thelocking screws used may not be able to maintain the fixed angularrelationship between the screws and plate under physiological loads.Specifically, the locking screws within the plate are only partiallycaptivated and thus only partially surrounded by threads. Under highstress and loading conditions, the locking plate hole may distort andallow the fixed angular relationship between the locking screw and plateto change. This can result in loss of fixation or loss of establishedintraoperative plate orientation. Additionally, because of the platehole geometry, translation of the plate with the non-locking screws islimited to one direction only. This may be a disadvantage in reductionand manipulation of fragments.

Thus, there exists a need for an improved bone plating system thatovercomes the deficiencies of the prior art.

SUMMARY OF THE INVENTION

The bone plating system for fixation of bone according to the presentinvention includes a bone plate having an upper surface, abone-contacting surface, at least one first hole passing through theupper and bone-contacting surfaces and having a thread, and at least onesecond hole passing through the upper and bone-contacting surfaces. Thebone plating system also includes a first screw having a shaft with athread for engaging bone and a head with a thread configured anddimensioned to mate with the thread of the first hole, and a secondscrew having a shaft with a thread for engaging bone and a head. Thefirst and second screws remain seated in their respective holes forsubstantially as long as the bone plate is implanted. Preferably, thebone plate includes a plurality of first and second holes, and acorresponding plurality of first and second screws are provided.

In order to facilitate insertion, the first and second screws can be aself-tapping screws. These screws can also be self-drilling screws.Additionally, the first and second screws can be cannulated forinsertion of a guide wire to guide screw placement. The first plate holecan have a substantially conical shape with a double-lead thread.

In one embodiment, the bone plate has a trapezoidal shaped cross sectionin regions between the first and second plate holes for minimizingcontact between bone and the bone-contacting surface. Additionally, atleast one of the second plate holes is longitudinally elongated and hasan edge inclined at an angle to the upper surface toward thebone-contacting surface for displacing the bone plate when engaged bythe head of a second bone screw.

In an exemplary embodiment, the bone plate includes a head portionconfigured and dimensioned to conform to a metaphysis of a bone and ashaft portion configured and dimensioned to conform to a diaphysis of abone. The head portion has only first plate holes and the shaft portionhas both first and second plate holes. In one embodiment, the headportion has a curved surface, includes an anterior fork substantiallyparallel to an anterior side of the shaft portion, and includes aposterior fork extending out from a posterior side of the shaft portion.In another embodiment, the head portion flares outward from the shaftportion and is curved, tapered, and twisted. The head portion can alsobe provided with suture holes from suture anchoring of the bone plate.

The method for fracture fixation of bone according to the presentinvention comprises the steps of reducing the fracture to bring bonefragments in close apposition; compressing a bone plate against the bonewith at least one first fastener to hold the fracture reduction; andsecuring at least one second fastener at a fixed angular relationship tothe bone plate. The first fasteners are inserted before the secondfasteners and both the first and second fasteners remain in bone forsubstantially as long as the bone plate is implanted.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of one embodiment of a non-locking screw accordingto the present invention;

FIG. 2 is a side view of one embodiment of a locking screw according tothe present invention;

FIG. 3 is a perspective view of a portion of a bone plate according tothe present invention;

FIG. 4 shows a cross-sectional view of one of the first plate holesthrough line 4—4 of FIG. 3;

FIG. 5 shows a cross-sectional view of one of the second plate holesthrough line 5—5 of FIG. 3;

FIG. 6 shows another cross-sectional view of the second plate hole ofFIG. 5 through line 6—6 of FIG. 3;

FIG. 7 shows a top view of an embodiment of a bone plate according tothe present invention designed for use in the distal femur;

FIG. 8 shows a side view of the bone plate of FIG. 7;

FIG. 9 shows a perspective view of the bone plate of FIG. 7 implanted ina distal femur;

FIG. 10 shows a top view of the bone plate of FIG. 7 with various crosssections labeled;

FIG. 11 shows a cross-section of the bone plate of FIG. 7 through lineA—A;

FIG. 12 shows a cross-section of the bone plate of FIG. 7 through lineB—B;

FIG. 13 shows a cross-section of the bone plate of FIG. 7 through lineC—C;

FIG. 14 shows a cross-section of the bone plate of FIG. 7 through lineD—D;

FIG. 15 shows a cross-section of the bone plate of FIG. 7 through lineE—E;

FIG. 16 shows a cross-section of the bone plate of FIG. 7 through lineF—F;

FIG. 17 shows a cross-section of the bone plate of FIG. 7 through lineG—G;

FIG. 18 shows a cross-section of the bone plate of FIG. 7 through lineH—H;

FIG. 19 shows a cross-section of the bone plate of FIG. 7 through lineI—I

FIG. 20 shows a side view of an embodiment of a bone plate according tothe present invention designed for use in the proximal tibia;

FIG. 21 shows a top view of the bone plate of FIG. 20;

FIG. 22 shows a perspective view of the bone plate of FIG. 20 implantedin a proximal tibia;

FIG. 23 shows an end view of the bone plate of FIG. 20 with variouscross sections labeled;

FIG. 24 shows a cross-section of the bone plate of FIG. 21 through lineA—A;

FIG. 25 shows a cross-section of the bone plate of FIG. 21 through lineI—I; and

FIG. 26 shows a cross-section of the bone plate of FIG. 21 through lineD—D.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The bone plating system according to the present invention includes abone plate, non-locking screws, and locking screws. FIG. 1 shows anexample of a non-locking screw 10 that can be used with the presentinvention. In general and as described in more detail below, anysurgical screw that has a non-threaded head 12 of an appropriate sizeand geometry for select plate holes of the bone plate can be used.Non-locking screw 10 has a shaft 14 that is at least partially threadedfor attachment to bone. The length of shaft 14 and the shaft threadconfiguration can be selected for the particular application. As is wellknown in the art, the threads and a tip 16 can be made to beself-tapping and/or self-drilling to facilitate implantation. Shaft 14can also be cannulated with a channel for receiving a guide wire to aidin proper placement.

FIG. 2 shows an example of a locking screw 20 that can be used with thepresent invention. In general and as described in more detail below, anysurgical screw that has a head 22 with threads 24 can be used as long ashead 22 is of an appropriate size and geometry for select plate holes ofthe bone plate and threads 24 mate with the threads of the plate holes.Locking screw 20 has a shaft 26 that is at least partially threaded forattachment to bone. The length of shaft 26 and the shaft threadconfiguration can be selected for the particular application. As is wellknown in the art, the threads and a tip 28 can be made to beself-tapping and/or self-drilling to facilitate implantation. Shaft 26can be cannulated for receiving a guide wire.

FIG. 3 shows a portion of a bone plate 30 according to the presentinvention. Bone plate 30 can be made in different shapes and sizes foruse in a wide variety of clinical applications. Bone plate 30 includesan upper surface 32 and a bone contacting surface 34. Bone plate 30 hasa plurality of first plate holes 36 and a plurality of second plateholes 38. Each of first and second plate holes 36, 38 passes throughupper 32 and bone-contacting surfaces 34. Each first plate hole 36 has athread 40 that mates with thread 24 on head 22 of locking screw 20 tosecure locking screw 20 to bone plate 30 at a temporally fixed angularorientation. Second plate holes 38 are not threaded and receivenon-locking screws 10 with non-threaded heads 12. Insertion ofnon-locking screws 10 in second plate holes 38 draws the bone towardbone-contacting surface 34 to compress the bone. Thus, seating ofnon-locking screws 10 in second plate holes 38 compresses the boneagainst bone-contacting surface 34 and seating of locking screws 20 infirst plate holes 36 secures heads 22 to bone plate 30 for maintaining afixed angular relationship between locking screws 20 and bone plate 30.Simultaneous use of bone plate 30 with both non-locking and lockingscrews 10, 20 for as long as bone plate 30 is implanted providesstability between both the screw and bone plate and between the boneplate and bone. As non-locking screws 10 are generally secured incancellous bone, the threads on shaft 14 are typically larger than thethreads on shaft 26 of locking screws 20.

First plate holes 36 are preferably conical in shape. As shown in FIG.4, threads 40 on first plate holes 36 are also preferably double leadthreads. The double lead conical threads enables multiple threads toengage while maintaining a low profile. Additionally, the double leadconical threads are less susceptible to cross-threading compared toother threads, e.g. cylindrical threaded arrangements.

As seen best in FIGS. 5 and 6, second plate holes 38 are preferablydynamic compression unit (DCU) screw holes substantially similar tothose disclosed in reissued U.S. Pat. No. Re. 31,628 to Allgower et al.,the contents of which are incorporated herein by reference. The DCUscrew holes promote healing of the bone by compressing the fracture endstogether. Briefly, second plate holes 38 have an edge 42 which includesan oblique portion or ramp 44 having an inclination such that when ramp44 is engaged by the underside of head 12 of non-locking screw 10, boneplate 30 is displaced in a direction to move ramp 44 away fromnon-locking screw 10 and to cause bone plate 30 to apply a pressure tohold the fracture ends in tight engagement.

Bone-contacting surface 34 on bone plate 30 can be shaped to minimizecontact with bone. Limiting contact between the bone plate and bone hasa number of biological and mechanical advantages including reduceddamage to blood supply and easier plate removal. Providing bone plate 30with a trapezoidal cross section (FIG. 11) in the regions between firstand second plate holes 34, 36 is one way to minimize contact. Other waysare disclosed in U.S. Pat. Nos. 5,151,103; 5,053,036; 5,002,544; and4,838,252. The contents of these patents are incorporated herein byreference.

By combining locking screws and non-locking screws on the same boneplate, the present invention provides a novel mixed fixation. With thenon-locking screws, fracture reduction is held by friction between thebone plate and bone. This friction is generated by tightening thenon-locking screws in bone. However, micromotion between the non-lockingscrews and bone leads to bone resorption, and loss of reduction.Additionally, insertion of the non-locking screws requires bone towithstand the stresses of tightening of the screws. This results in highstress in bone surrounding the non-locking screws. Ordinarily, the highstress can cause the non-locking screw threads to strip (threads in bonefail in shear) and/or creep in bone (since bone is a viscoelasticmaterial). Either one of these phenomenon also results in loss ofreduction.

By adding at least one locking screw, loss of reduction is minimized oreliminated by the present invention. Specifically, by securing thelocking screws to the bone plate and not the bone, the effect of theviscoelastic behavior of bone is reduced, the threads do not strip, andmicromotion is prevented. The attachment between the locking screws andbone plate is a high strength connection in which the locking screw mustcut sideways through bone to fail.

As management of certain peri-articular fractures typically involvesinsertion of screws at various angles with respect to the bone plate andit is highly desirable to maintain the initial angular relationshipsbetween the individual screws and the bone plate, the bone platingsystem according to the present invention is particularly well-suitedfor these clinical applications. FIGS. 7–19 show a bone plate 50according to the present invention specifically designed for use in thedistal femur. Bone plate 50 would be used primarily for, but not limitedto, severely comminuted fractures including Hoffa type fractures.

Bone plate 50 has an upper surface 52 and a bone-contacting surface 54.Bone plate 50 has a plurality of threaded plate holes 56 a, 56 b, 56 c(collectively referred to as threaded plate holes 56) for receivinglocking screws 20 and a plurality of non-threaded plate holes 58 forreceiving non-locking screws 10. Each of threaded and non-threaded plateholes 56, 58 passes through upper 52 and bone-contacting surfaces 54. Aswas the case for bone plate 30, the thread on threaded plate holes 56mates with threaded head 22 of locking screw 20 to secure locking screw20 to bone plate 50 at a temporally fixed angular orientation andinsertion of non-locking screws 10 in non-threaded plate holes 58 drawsthe bone toward bone-contacting surface 54 to compress the bone.

Bone plate 50 includes a head portion 60 configured and dimensioned toconform to the metaphysis of the distal femur and a shaft portion 62configured and dimensioned to conform to a diaphysis of a bone. As bestseen in FIG. 8, bone contacting surface 54 of head portion 60 is acurved surface to fit the contours of the distal femur. Head portion 60includes an anterior fork 64 substantially parallel to an anterior side66 of shaft portion 62 and a posterior fork 68 extending laterally outfrom a posterior side 70 of shaft portion 62.

The non-threaded plate holes 58 are preferably dynamic compression unit(DCU) screw holes substantially similar to second plate holes 38. Shaftportion 62 has both threaded plate holes 56 a and non-threaded plateholes 58 so that both locking and non-locking screws can be used inshaft portion 62. The ability to use locking screws in shaft portion 62is particularly useful when the far cortex of part of the diaphysis ismissing or severely damaged since fixation with non-locking screws isproblematic because of the condition of the far cortex. As best seen inFIG. 11, the regions between threaded and non-threaded plate holes 56 a,58 have a trapezoidal cross section that limits contact betweenbone-contacting surface 54 of shaft portion 62 and the femur. Shaftportion 62 terminates in a tapered tail 72 (FIG. 19).

In contrast to shaft portion 62, head portion 60 contains only threadedholes 56. Specifically, threaded plate holes 56 b that surround acentrally located threaded plate hole 56 c. Threaded plate hole 56 c hasa larger diameter than threaded plate holes 56 b to accommodate alocking screw with a larger diameter, e.g. threaded plate hole 56 b havea diameter of 5.0 mm and threaded plate hole 56 c has a diameter of 7.3mm. FIGS. 12–18 show the various angular orientations of the individualthreaded holes 56 b, 56 c. In generally, threaded holes 56 b, 56 c arearranged so that the inserted locking screws converge towards eachother. It should be noted that, if a surgeon elects, non-locking screwscan be used in any of threaded plate holes 56. Finally, it should alsobe noted that bone plate 50 has several structural differences from thecondylar buttress plate commercially available from Synthes (U.S.A.) ofPaoli, Pa. For example, the head of the condylar buttress plate iscontoured in both the longitudinal and transverse directions while headportion 60 of bone plate 50 is contoured only in the longitudinaldirection for a more anatomical fit. Additionally, tail 72 has anelevated end to get under tissue.

FIGS. 20–26 show a bone plate 80 according to the present inventionspecifically designed for use in the proximal tibia. Bone plate 80 wouldbe primarily used for, but not limited to fractures of the lateralproximal tibial plateau. Bone plate 80 has an upper surface 82 and abone-contacting surface 84. Bone plate 80 has a plurality of threadedplate holes 86 a, 86 b and 86 c (collectively referred to as threadedplate holes 86) for receiving locking screws 20 and a plurality ofnon-threaded plate holes 88 for receiving non-locking screws 10. Each ofthreaded and non-threaded plate holes 86 and 88 pass through upper 82and bone-contacting surfaces 84. As was the case for bone plate 30, thethreads on threaded plate holes 86 mate with the threaded head 22 oflocking screw 20 to secure locking screw 20 to bone plate 80 at a fixedangular orientation. Insertion of non-locking screws 10 in non-threadedplate holes 88 draws the bone-contacting surface 84 toward the bone tocompress the plate to the bone.

Bone plate 80 includes a head portion 90 configured and dimensioned toconform to the metaphysis of the lateral proximal tibia and a shaftportion 92 configured and dimensioned to conform to a diaphysis of thelateral proximal tibia. As seen in FIGS. 20 and 26, bone contactingsurface 84 of head portion 90 is a curved, tapered, and twisted to fitthe contours of the lateral proximal tibial plateau. Head portion 90also features sutures holes for suture anchoring and for provisionalfixation of bone plate 80.

The non-threaded plate holes 88 are preferably dynamic compression unit(DCU) screw holes substantially similar to second plate holes 38. Shaftportion 92 has both threaded plate holes 86 a and non-threaded plateholes 88 so that both locking and non-locking screws can be used inshaft portion 92. The ability to use locking screws in shaft portion 92is particularly useful when the far cortex of part of the diaphysis ismissing or severely damaged since fixation with non-locking screws isproblematic because of the condition of the far cortex. As best seen inFIG. 24, the regions between threaded and non-threaded plate holes 86 aand 88 have a rectangular cross section that limits contact betweenbone-contacting surface 84 of shaft portion 92 and the tibia. Shaftportion 92 terminates in a tapered tail 102 (FIG. 25).

In similar fashion to shaft portion 92, head portion 90 containsthreaded holes 86 and non-threaded holes 88. Head portion 90 featuresthreaded plate holes 86 b and 86 c. Holes 86 b and 86 c have a diameterof 5.0 mm and are oriented as shown in FIGS. 23 and 26. In general,threaded holes 86 b, 86 c are arranged so that the inserted lockingscrews converge towards each other. As shown in FIG. 23, plate holes 86b are oriented to converge at a predetermined distance from platesurface 84 to optimize the position of locking screws 20 within thetibia plateau. As shown in FIG. 26, plate hole 86 c is oriented toconverge with plate hole 86 b at predetermined distance to provideadditional stability to the locked fixed-angle construct. It should benoted that if a surgeon elects, non-locking screws can be used in any ofthreaded plate holes 86.

While it is apparent that the illustrative embodiments of the inventionherein disclosed fulfill the objectives stated above, it will beappreciated that numerous modifications and other embodiments may bedevised by those skilled in the art. For example, for some fracturesonly one first plate hole and one second plate hole are needed, althoughat least two of each is advantageous. Furthermore, additional plateholes without screws can be present in the plate, if desired to allowthe surgeon further flexibility in use. Therefore, it will be understoodthat the appended claims are intended to cover all such modificationsand embodiments which come within the spirit and scope of the presentinvention.

1. A bone plating system for improving the stability of a bone fracturein a long bone comprising: a bone plate having: an upper surface; alower surface; a shaft portion having a width and a central longitudinalaxis, the shaft portion configured and dimensioned to extend along atleast a portion of a diaphysis of the bone and the lower surface of theshaft portion having a plurality of arched cut-outs extending transverseto the longitudinal axis; and a head portion that flares outward fromthe shaft portion so as to have a width that is greater than the widthof the shaft portion, the head portion curving upward from the shaftportion and having at least three bone anchor holes, the bone anchorholes being conically tapered from the upper surface to the lowersurface, the at least three bone anchor holes having at least a portionthat has a thread to engage a thread on a head of a bone anchor, whereinthe head portion has only bone anchor holes having the threaded portion,the shaft portion having a plurality of holes having at least a portionthat has a thread to contact the thread on the head of a bone anchor. 2.The bone plating system of claim 1, wherein the threaded holes in theshaft portion are offset from the central longitudinal axis of the shaftportion.
 3. The bone plating system of claim 2, wherein the threadedholes in the shaft portion alternate sides from the central longitudinalaxis of the shaft, such that the holes in the shaft portion form astaggered arrangement.
 4. The bone plating system of claim 1, whereinthere are at least five holes in the shaft portion.
 5. The bone platingsystem of claim 1, wherein at least two of the holes in the head portionhave diameters different from each other.
 6. The bone plating system ofclaim 1, wherein the internal surface of at least one of the holes inthe shaft portion has at least a portion which is smooth.
 7. The boneplating system of claim 6, wherein the smooth portion of the threadedhole is at the upper portion of the hole.
 8. The bone plating system ofclaim 7, wherein the smooth upper portion of the hole tapers inward in adirection from the upper surface of the plate to the lower surface ofthe plate.
 9. The bone plating system of claim 1, wherein at least aportion of the head portion is thinner than at least a portion of theshaft portion.
 10. The bone plating system of claim 1, wherein the headportion lies in a plane different from the plane in which the shaftportion lies.
 11. The bone plating system of claim 1, wherein the shaftportion of the bone plate has a thinner cross section in regions betweenthe plate holes.
 12. The bone plating system of claim 11, wherein theshaft portion of the bone plate has a trapezoidal shaped cross sectionin regions between the plate holes for minimizing contact between thebone and the lower surface.
 13. The bone plating system of claim 1,wherein the lower surface of the shaft portion of the bone plate iscurved along a direction transverse to the longitudinal axis of theshaft portion.
 14. The bone plating system of claim 1, wherein the boneplate includes at least one hole for provisional fixation of the boneplate.
 15. The bone plating system of claim 14, wherein the at least oneprovisional fixation hole is an unthreaded suture hole.
 16. The boneplating system of claim 15, wherein the suture hole is located in thehead portion.
 17. The bone plating system of claim 1, wherein thethreaded portion of each bone-anchor hole has a multiple-lead thread.18. The bone plating system of claim 1, wherein the bone plate isconfigured and dimensioned for use with the tibia.
 19. The bone platingsystem of claim 1, wherein the bone plate is configured and dimensionedfor use with the femur.
 20. The bone plating system of claim 1, whereinthe head portion is curved in at least two planes.
 21. The bone platingsystem of claim 1, wherein the bone plate has a portion that is curved.22. The bone plating system of claim 1, wherein the holes have adiameter between approximately 5 mm and approximately 7 mm.
 23. The boneplating system of claim 1, wherein the holes in the head portion arearranged and positioned so that the inserted anchors converge towardseach other.
 24. A bone plating system for improving the stability of abone fracture in a long bone comprising: a bone plate having: an uppersurface; a lower surface; a shaft portion having a width and a centrallongitudinal axis, the shaft portion configured and dimensioned toextend along at least a length of a diaphysis of the bone and the lowersurface of the shaft portion having a plurality of arched cut-outsextending transverse to the longitudinal axis; and a head portion havinga width that is greater than the width of the shaft portion and whichcurves upward from the shaft portion, the head portion having aplurality of conically tapered holes having at least a portion that hasa thread to contact a bone anchor, wherein the shaft portion has aplurality of conically tapered holes having at least a portion that hasa thread to contact a thread on the head of a bone anchor, and the shaftportion of the bone plate has a thinner cross section in regions betweenthe plate holes.
 25. The bone plating system of claim 24, wherein theconically tapered holes in the shaft portion are offset from the centrallongitudinal axis of the shaft portion.
 26. The bone plating system ofclaim 25, wherein the conically tapered holes in the shaft portionalternate sides from the central longitudinal axis of the shaft, suchthat the holes in the shaft portion form a staggered arrangement. 27.The bone plating system of claim 24, wherein at least one of the holesin the head portion has a non-perpendicular angular orientation withrespect to the plane defined by the upper surface of the plate.
 28. Thebone plating system of claim 27, wherein the hole angle is betweenapproximately 0° and approximately 15°.
 29. The bone plating system ofclaim 24, wherein the shaft portion further comprises a plurality ofholes without threads.
 30. The bone plating system of claim 24, whereinthere are at least three holes in the head portion.
 31. The bone platingsystem of claim 24, wherein there are at least five holes in the shaftportion.
 32. The bone plating system of claim 24, wherein all of theholes located in the head portion for receiving bone anchors have atleast a portion that is threaded.
 33. The bone plating system of claim24, wherein at least two of the holes in the head portion have diametersdifferent from each other.
 34. The bone plating system of claim 24,wherein the internal surface of at least one of the threaded holes inthe shaft portion has at least a portion which is smooth.
 35. The boneplating system of claim 34, wherein the smooth portion of the threadedhole is at the upper portion of the hole.
 36. The bone plating system ofclaim 35, wherein the smooth upper portion of the hole tapers inward ina direction from the upper surface of the plate to the lower surface ofthe plate.
 37. The bone plating system of claim 24, wherein at least aportion of the head portion is thinner than at least a portion of theshaft portion.
 38. The bone plating system of claim 24, wherein the headportion lies in a plane different from the plane in which the shaftportion lies.
 39. The bone plating system of claim 24, wherein the shaftportion of the bone plate has a trapezoidal shaped cross section inregions between the plate holes for minimizing contact between bone andthe lower surface.
 40. The bone plating system of claim 24, wherein thelower surface of the shaft portion of the bone plate is curved along adirection transverse to the longitudinal axis of the shaft portion. 41.The bone plating system of claim 24, wherein the bone plate includes atleast one hole for provisional fixation of the bone plate.
 42. The boneplating system of claim 41, wherein the at least one provisionalfixation hole is an unthreaded suture hole.
 43. The bone plating systemof claim 42, wherein the suture hole is located in the head portion. 44.The bone plating system of claim 24, wherein the threaded portion has amultiple-lead thread.
 45. The bone plating system of claim 24, whereinthe bone plate is configured and dimensioned for use with the tibia. 46.The bone plating system of claim 24, wherein the bone plate isconfigured and dimensioned for use with the femur.
 47. The bone platingsystem of claim 24, wherein the head portion is curved in at least twoplanes.
 48. The bone plating system of claim 24, wherein the bone platehas a portion that is curved.
 49. The bone plating system of claim 24,wherein the holes have a diameter between approximately 5 mm andapproximately 7 mm.
 50. The bone plating system of claim 24, wherein theholes in the head portion are arranged and positioned so that theinserted anchors converge towards each other.
 51. The bone platingsystem of claim 50, wherein at least one of the holes in the headportion has a non-perpendicular angular orientation with respect to theplane defined by the upper surface of the plate.
 52. The bone platingsystem of claim 51, wherein the hole angle is between approximately 0°and approximately 15°.
 53. A bone plating system for improving thestability of a bone fracture in a long bone comprising: a bone platehaving: an upper surface; a lower surface; a shaft portion having awidth and a longitudinal axis, the lower surface of the shaft portionhaving a plurality of arched cut-outs extending transverse to thelongitudinal axis; and a head portion having a width that is greaterthan the width of the shaft portion, the head portion having a pluralityof conically tapered holes having at least a portion that has a threadto contact a bone anchor, wherein the shaft portion has a plurality ofconically tapered holes having at least a portion that has a thread tocontact a thread on the head of a bone anchor, and the shaft portion ofthe bone plate has a thinner cross section in at least one regionbetween at least two holes in the shaft portion.
 54. The bone platingsystem of claim 53, wherein the bone plate includes at least onenon-threaded screw hole.
 55. The bone plating system of claim 53,wherein the bone plate includes at least one non-threaded suture hole.